Skip to main content
release_alert
Welcome to the new Scholars 3.0! Read about new features and let us know what you think.
cancel
Journal cover image

Probability of severe frailty development among operative and nonoperative adult spinal deformity patients: an actuarial survivorship analysis over a 3-year period.

Publication ,  Journal Article
Passias, PG; Segreto, FA; Bortz, CA; Horn, SR; Pierce, KE; Naessig, S; Brown, AE; Jackson-Fowl, B; Ahmad, W; Oh, C; Lafage, V; Lafage, R ...
Published in: Spine J
August 2020

BACKGROUND: Little is known of how frailty, a dynamic measure of physiological age, progresses relative to age or disability status. Operative treatment of adult spinal deformity (ASD) may play a role in frailty remediation and maintenance. PURPOSE: Compare frailty status, severe frailty development, and factors influencing severe frailty development among ASD patients undergoing operative or nonoperative treatment. DESIGN: Retrospective review with maximum follow-up of 3 years. SETTING: Prospective, multicenter, ASD database. PARTICIPANTS: Patients were consecutively enrolled from 13 participating centers. INCLUSION CRITERIA: ≥18 years undergoing either operative or nonoperative treatment for ASD, exclusion criteria: spinal deformity of neuromuscular etiology, presence of active infection, or malignancy. The mean age of the participants analyzed were 54.9 for the operative cohort and 55.0 for the nonoperative cohort. OUTCOMES MEASURES: Frailty status, severe frailty development, and factors influencing severe frailty development. METHODS: ASD patients (coronal scoliosis ≥20°, sagittal vertical axis (SVA) ≥5 cm, Pelvic Tilt (PT) ≥25°, or thoracic kyphosis ≥60°) >18 y/o, with Base Line (BL) frailty scores were included. Frailty was scored from 0 to 1 (not frail: <0.3, frail 0.3-0.5, severe frailty >0.5) through the use of ASD-frailty index (FI) which has been validated using the International Spine Study Group (ISSG) ASD database, European Spine Study Group ASD database, and the Scoli-RISK-1 Patient Database. The ISSG is funded through research grants from DePuy Synthes and individual donations and supported the current work. Operative (Op) and Nonoperative (Non-Op) patients were propensity matched. T-tests compared frailty among treatment groups and BL, 1, 2, and ≥3 years. An actuarial Kaplan-Meier survivorship analysis with log-rank (Mantel-Cox) test, adjusting for patients lost to follow-up, determined probability of severe frailty development. Multivariate Cox Regressions gauged the effect of sagittal malalignment, patient and surgical details on severe frailty development. RESULTS: The analysis includes 472 patients (236 Op, 236 Non-Op) selected by propensity score matching from a cohort of 1,172. Demographics and comorbidities were similar between groups (p>.05). Op exhibited decreased frailty at all follow-up intervals compared with BL (BL: 0.22 vs Y1: 0.18; Y2: 0.16; Y3: 0.15, all p<.001). Non-Op displayed similar frailty from BL to 2Y follow up, and increased frailty at 3Y follow up (0.23 vs 0.25, p=.014). Compared with Non-Op, Op had lower frailty at 1Y (0.18 vs 0.24), 2Y (0.16 vs 0.23), and 3Y (0.15 vs 0.25; all p<.001). Cumulative probability of maintaining nonsevere frailty was (Op: 97.7%, Non-Op: 94.5%) at 1Y, (Op: 95.1%, Non-Op: 90.4%) at 2Y, and (Op: 95.1%, Non-Op: 89.1%) at ≥3Y, (p=.018). Among all patients, baseline depression (hazard ratio: 2.688[1.172-6.167], p=.020), Numeric Rating Scale (NRS) back pain scores (HR: 1.247[1.012-1.537], p=.039), and nonoperative treatment (HR: 2.785[1.167-6.659], p=.021) predicted severe frailty development with having a HR>1.0 and p value<.05. Among operative patients, 6-week postoperative residual SVA malalignment (SRS-Schwab SVA+modifier) (HR: 15.034[1.922-116.940], p=.010) predicted severe frailty development indicated by having a HR>1.0 and p value <.05. CONCLUSIONS: Non-Op patients were more likely to develop severe frailty, and at a quicker rate. Baseline depression, increased NRS back pain scores, nonoperative treatment, and postoperative sagittal malalignment at 6-week follow-up significantly predicted severe frailty development. Operative intervention and postoperative sagittal balance appear to play significant roles in frailty remediation and maintenance in ASD patients. Frailty is one factor, in a multifactorial conservation, that may be considered when determining operative or nonoperative values for ASD patients. Operating before the onset of severe frailty, may result in a lower complication risk and better long-term clinical outcomes.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Spine J

DOI

EISSN

1878-1632

Publication Date

August 2020

Volume

20

Issue

8

Start / End Page

1276 / 1285

Location

United States

Related Subject Headings

  • Survivorship
  • Retrospective Studies
  • Quality of Life
  • Prospective Studies
  • Probability
  • Orthopedics
  • Lordosis
  • Humans
  • Frailty
  • Adult
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Passias, P. G., Segreto, F. A., Bortz, C. A., Horn, S. R., Pierce, K. E., Naessig, S., … International Spine Study Group, . (2020). Probability of severe frailty development among operative and nonoperative adult spinal deformity patients: an actuarial survivorship analysis over a 3-year period. Spine J, 20(8), 1276–1285. https://doi.org/10.1016/j.spinee.2020.04.010
Passias, Peter G., Frank A. Segreto, Cole A. Bortz, Samantha R. Horn, Katherine E. Pierce, Sara Naessig, Avery E. Brown, et al. “Probability of severe frailty development among operative and nonoperative adult spinal deformity patients: an actuarial survivorship analysis over a 3-year period.Spine J 20, no. 8 (August 2020): 1276–85. https://doi.org/10.1016/j.spinee.2020.04.010.
Passias, Peter G., et al. “Probability of severe frailty development among operative and nonoperative adult spinal deformity patients: an actuarial survivorship analysis over a 3-year period.Spine J, vol. 20, no. 8, Aug. 2020, pp. 1276–85. Pubmed, doi:10.1016/j.spinee.2020.04.010.
Passias PG, Segreto FA, Bortz CA, Horn SR, Pierce KE, Naessig S, Brown AE, Jackson-Fowl B, Ahmad W, Oh C, Lafage V, Lafage R, Smith JS, Daniels AH, Line BG, Kim HJ, Uribe JS, Eastlack RK, Hamilton DK, Klineberg EO, Burton DC, Hart RAA, Schwab FJ, Shaffrey CI, Ames CP, Bess S, International Spine Study Group. Probability of severe frailty development among operative and nonoperative adult spinal deformity patients: an actuarial survivorship analysis over a 3-year period. Spine J. 2020 Aug;20(8):1276–1285.
Journal cover image

Published In

Spine J

DOI

EISSN

1878-1632

Publication Date

August 2020

Volume

20

Issue

8

Start / End Page

1276 / 1285

Location

United States

Related Subject Headings

  • Survivorship
  • Retrospective Studies
  • Quality of Life
  • Prospective Studies
  • Probability
  • Orthopedics
  • Lordosis
  • Humans
  • Frailty
  • Adult